1Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
39Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
World J Emerg Surg. 2018 Jun 19;13:24. doi: 10.1186/s13017-018-0185-2. eCollection 2018.
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups.
The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion.
Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention.
This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
黏连性小肠梗阻（ASBO）是一种常见的外科急症，导致高发病率，甚至一些死亡率。引起这种肠梗阻的黏连通常是以前腹部手术的痕迹。本文提出了修订后的博洛尼亚指南，用于 ASBO 的基于证据的诊断和治疗。工作组增加了关于 ASBO 预防和特殊患者群体的段落。
该指南由世界急诊外科学会的 ASBO 工作组在其主持下编写。在更新指南之前，进行了系统的文献检索，以确定关于 ASBO 的流行病学、诊断和治疗的新论文。根据循证指南制定方法对文献进行了批判性评估。最终建议考虑到结论的证据水平，经工作组批准。
微创技术和使用黏连屏障可能会减少黏连形成。大多数 ASBO 患者的非手术治疗有效。非手术治疗的禁忌症包括腹膜炎、绞窄和缺血。当梗阻的黏连病因不确定，或者非手术管理的禁忌症可能存在时，CT 是首选的诊断技术。非手术治疗的原则是经口、鼻胃管或长管减压，以及静脉补液和电解质。当需要手术治疗时，腹腔镜方法可能对某些简单的 ASBO 病例有益。年轻患者的复发性 ASBO 终生风险较高，因此可能受益于应用黏连屏障作为一级和二级预防。
本指南为治疗 ASBO 患者的外科医生提供了建议。ASBO 管理的某些方面的科学证据不足，特别是与特殊患者群体相关的方面。期待一项腹腔镜与开放手术治疗 ASBO 的随机试验结果。
